With the rising popularity of fillers for facial rejuvenation coupled with the paucity of regulations on credentialing of qualified injectors, the number of filler related complications is increasing. Although the majority of complications are mild, vascular occlusion is the most feared and dangerous. Minimizing risk of vascular complications through a comprehensive understanding of vascular anatomy and careful technique is important. Physicians who perform filler injections should also be able to promptly recognize complications and manage them. We report a case of vascular occlusion successfully managed using high dose hyaluronidase and provide a review of the literature including incidence, management, and techniques to prevent vascular complications. J Drugs Dermatol. 2019;18(6):587-591.